Health care is key for Democrats in shutdown fight. Here’s what to know.

The federal government shut down early Wednesday following an acrimonious deadlock in Congress over spending in which Democrats have sought to put a spotlight on health care subsidies and who is eligible to receive coverage.

Senate Democrats rejected a Republican-led proposal that would have extended funding at current levels until Nov. 21, voting nearly along party lines. The shutdown is the first since January 2019, when President Donald Trump was previously in office.

Democrats had said they could not support a GOP-led funding extension until Republicans agreed to certain concessions on health care policy, primarily the continuation of pandemic-era Affordable Care Act subsidies that were set to expire by the end of the year.

Republicans countered those demands by lying that Democrats were trying to force the government to provide full health care benefits to undocumented immigrants.

Trump’s sweeping tax and immigration bill, which was passed in July, rolled back significant portions of the Affordable Care Act, popularly known as Obamacare, and Democrats had called for at least some of the cuts to President Barack Obama’s signature law to be reversed.

Here’s what to know.

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What do Democrats say they want in the shutdown?

House and Senate Democrats argue that Trump’s One Big Beautiful Bill will increase health care costs for Americans, and they said they would use what leverage they have in the upper chamber to try to secure changes to provide relief for those affected.

In a meeting Monday with Trump, Senate Minority Leader Charles E. Schumer (D-N.Y.) and House Minority Leader Hakeem Jeffries (D-N.Y.) raised some key requests, including the extension of subsidies for those with insurance through the ACA marketplace that have been in place since the pandemic. They asked for those requests to be included in the funding bill and a guarantee from the White House not to unilaterally cut health care funding later.

Republicans, meanwhile, have said they are willing to negotiate on the ACA subsidy extension only when the government is open again. Moderates have pushed for the extension, but the more conservative members have vowed to block it, leaving the party split on the matter.

The impact of not extending the tax credits will probably be felt widely: With the expiration of enhanced tax credits, ACA marketplace consumers’ out-of-pocket premiums will increase more than 75% on average, an analysis by health policy group KFF found. Separately, KFF found that insurers’ median proposed premium increase for 2026 to be about 18%, more than double last year’s median proposed increase of 7 percent.

Without an extension of the ACA subsidies, the nonpartisan Congressional Budget Office estimates that about 4 million people could lose insurance coverage over the next decade.

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Republicans make false claim about health care for undocumented immigrants

Republican leaders have falsely repeated the claim that Democratic lawmakers are trying to force the government to offer full health care benefits to undocumented immigrants.

“The Democrats want Illegal Aliens, many of them VIOLENT CRIMINALS, to receive FREE Healthcare,” Trump said last week in a post on Truth Social. He added, “We cannot let this happen!”

Vice President JD Vance echoed that, saying on X on Sept. 25 that “Democrats are about to shutdown the government because they demand we fund healthcare for illegal aliens.” An X post from the Senate Republicans account showed an illustration of a ransom note with a list of purported “Democrat Demands,” including “Give illegal aliens free healthcare.”

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Are undocumented immigrants eligible for federally funded health care?

Undocumented immigrants, as well as many legal immigrants, are already ineligible for most federal benefits.

According to HealthCare.gov, U.S. citizens, U.S. nationals and lawfully present immigrants are eligible for coverage through the Health Insurance Marketplace.

The website states: “Undocumented immigrants can’t get Marketplace health coverage. They may apply for coverage on behalf of documented individuals.”

On Tuesday, Schumer accused Republicans of lying to the public by repeating their claim that undocumented immigrants have access to federally funded health care.

“Republicans know perfectly well that undocumented immigrants are already prohibited … from getting insurance on ACA, Medicare or Medicaid,” Schumer told reporters in the Capitol. “They know perfectly well not a single sentence or clause or comma that we’re pushing in our bill does that, but they’re lying, because they know they’re screwed.”

Republicans and the White House, however, have taken up issue with Emergency Medicaid — a federal program that reimburses hospitals nationwide for emergency care provided to uninsured people who don’t qualify for Medicaid because of their immigration status. But that program does not provide coverage for individuals.

Under the Emergency Medical Treatment and Labor Act, emergency rooms are obligated to treat everyone, including undocumented immigrants. If an undocumented immigrant is unable to pay an emergency room bill, hospitals are left with the debt, and Emergency Medicaid covers that expense for hospitals.

On Wednesday, Vance made clear that Republicans want to change that.

“If you’re an American citizen, and you’ve been to a hospital in the last few years, you’ve probably noticed that wait times are especially large, and very often somebody who’s there in the emergency room waiting is an illegal alien,” Vance told reporters at the White House. “ … Why do those people get health care benefits at hospitals paid for by American citizens?”

However, according to KFF, Emergency Medicaid spending represented less than 1% of overall Medicaid spending between fiscal years 2017 and 2023. As KFF experts explained in an analysis, without Emergency Medicaid, hospitals or state governments would be left with the costs of emergency care.

Republicans have also taken issue with some state budgets funding health care for all immigrants, regardless of their legal status. Fourteen states plus D.C. offer state-funded coverage for all children, regardless of status, and seven states — including California, Illinois, New York, Oregon — plus D.C. have expanded state-funded coverage to some income-eligible adults, regardless of their immigration status. Three of these states, however, began scaling back their coverage of immigrants because of budget constraints.

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Why do Republicans say Democrats want $1.5 trillion in spending?

Last month, Democrats presented their own government funding extension plan, ahead of the shutdown deadline. In a statement announcing the plan, Schumer said: “The legislation would address the healthcare crisis that President Trump and Republican lawmakers have single-handedly created by reversing the catastrophic healthcare cuts that would kick millions off their coverage and permanently extend the premium ACA tax credits.”

Their proposed plan sought to make the ACA subsidies permanent and reverse the $1 trillion in Medicaid cuts in Trump’s One Big Beautiful Bill.

The proposal to make ACA subsidies permanent would increase the deficit by almost $350 billion in the next decade and increase the number of people insured by 3.8 million, a Congressional Budget Office analysis concluded.

Republicans attacked the Democrats over their proposal — which also included language to increase oversight of administration spending authorized by Congress and return millions of dollars to public broadcasting — describing it as a “$1.5 trillion ransom note to taxpayers.”

They also cast the shutdown as a deliberate ploy by the Democrats.

Larry Levitt, executive vice president for health policy at KFF, noted in a Wednesday post on X that Democrats are “pushing to reverse Medicaid and ACA cuts.”

“Contrary to Republican talking points, that would not in any way expand health care eligibility for undocumented immigrants,” he said.